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Revision TKR Mamie's Recovery Thread

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Mamie

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Good Morning Kneeper and sisters-in-Him,

I have often wished the requirements to pass the college exam for medical is that they or one they are attached to, go through these grueling procedures. Or a PT go through what they dish out.

I have, from the start not taken much pain meds as she is stingy and I have had to chose which time of day is worse ,in order to make it in-between appointments. I am only using pain meds 3 times a day with one of them just being Tylenol and muscle relaxer. It has never been enough but there will not be more.The Dilauid was in small doses of which their effect is only good for 3 hours, never making it from one dose to something else. Today the worse pain is in my thigh and it is burning hot. I can only assume it is from the infection. I have called but get no reply or get put on indefinite hold by the Call Center.

There is improvement in both my knee and infection site. It is almost closed back up and still draining.

Have a great day!
Mamie
 

lovetocookandsew

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I wasn't aware of this possibility, but after my revision I started having a new sharp pain in my upper thigh. My OS told me it was called, "tip of stem pain", and would go away with time. Apparently, our bones move, but the metal rods they insert don't, so as we move around the bone and tip of the stem can clash a bit, causing pain. It's a pain that will diminish and go away over time, but I'd mention your pain to your OS, not his PA, and ask him what he thinks, and also ask him what he can do about it if it is the stem tip pain.
 

lovetocookandsew

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Oh, by "ask him what he can do about it", I meant see if he can give you something for the pain. He can't do anything to stop the pain-that takes time and patience, but he might give you something for the pain if you talk to him about it.
 
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Hello There!

I am now in my 7th week but still struggling with pain and swelling. I work every day on the exercises but each day it swells more but again it gets hot. But, now I have a question that comes from my PT. Last week in PT I was told my bend (ROM) was an easy 80 degrees. Yesterday, I was at 80 degrees with no gain. She said I hit a plateau. Does that mean I will not gain further range? She asks how I would feel if this was all I get or if I may consider what this surgeon is planning which is a MUA. I have been set against it but now I am wondering. I believe, that I have made good progress after having to deal with so many complications. My leg is almost closed from where it erupted due to fluid retention and infection setting in. However, in spite of these many problems, the incision, though ugly is coming along. I do not want to be set back and do not want to get stuck at 80 degrees, but doing a MUA? .Friday I see the surgeon and PA. Finally, if the MUA is so painful as I have heard many times, is this an outpatient procedure?

Thank you.
 

Pumpkln

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@Mamie,
A plateau is a temporary pause in recovery, as your knee heals and swelling goes down your ROM will improve.
People learning a new sport hit plateau's, then with practice continue to improve. People losing weight hit plateaus, only to break through with time.
With a wound that is still healing and not fully closed, a MUA would risk opening it up again with the stress on the tissues during a MUA.

Please do not let the surgeon or PT rush you, what you and your soft tissue have been through will take time to heal. IMO having a MUA at this time will only cause further inflammation and swelling, risking a set back to your recovery.

Here are the ROM numbers of members who's ROM was slow in reaching its potential.

Campervan’s ROM history
92 - 8 weeks post op
105 - 10 weeks
107 - 5 months
110 - 6 months
112 - 7 months
116 - 9 months
119 - 11 months
118 - 1 yr
120 - 1yr 2 months
125 - 1 yr 8 months and still this now at 1yr 10 months

Bertschb’s ROM history
1 month
- 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees



TortiTabby's ROM
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
It has now been 26 weeks and all I do is ADL.
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better.
 

kneeper

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I hit a plateau in my recovery. Swelling had come down some and I had gained, then I stalled. A couple of weeks later the swelling improved and the bend had increased. I didn't exercise my way into more gain. I really took it pretty easy--lots of ice and elevation and a few heel slides. I had done nothing different in week 6 than had in week 4 and yet I had made progress.
So just hang in there with the ice, elevation and gentle motions and one of these days you'll see improvement again. (Help your incision heal by not overdoing and increasing the swelling.)
 
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Mamie

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Oh Pumpkin, do you really think so? I've been so torn today knowing what's coming Friday when I see the Surgeon and PA. They are not going to give me any pain meds of any kind. It was established that because they forgot my Ted hose, did not ice or elevate my leg in the hospital, it caused my leg to blow up. When I left the hospital no shoe would fit my foot as my leg was so huge. 17 pounds of fluid put so much pressure on the incision area it pulled apart several areas. Thats where the infection set in. It looked to them to be superficial at first but when it would not heal further investigation proved the infection ran deep. I am praying that it did not get to the new parts. I told them that pushing my leg could spread the infection. Your reply has given me courage I lost temporarily and reason to push harder but not on my knee but on this people in my health care team to lighten up. I told them already I belonged to a support group online and they needed to refer their patients there as well. The numbers you sent, are way ahead of me for the most part but several were nt as far. Covid is growing bad here and I do not feel safe at PT. I am also going to request Home PT again due to our area growing is so bad and outpatient PT is packed. Thanks again.
 
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Hello Kneeper,

I had begun to feel lazy for not doing anything in our home or meals or laundry or just anything but baby my knee/leg and exercise gently. When PT told me I plateaued and what if I do not make further progress, was I prepared to help myself or be satisfied with what I have now. I have been very sick from this surgery-first with horrid blood pressure from such high levels of pain and then infection. Now, as sweet as they have been in PT I feel as though I was gently shoved into a frame of mind that if I do not help myself with MUA, the it is my fault. They did not say that but should have with what they did say. I cried most of the drive back home feeling as though I failed. I sat my husband down on the balcony off the bedroom as ask him what he thought. IF I were to ever go through the MUA, it should be with his concurrence. He is my partner in life and the one whose life gets prolonged with mine from any set-backs.

The numbers Pumpkin sent, are way ahead of me for the most part but several were not as far. Thank you. It further showed me again that we are all different. Too much interfered with my progress yet I am 20 degrees beyond where I started. I love you all for helping me sort out the garbage in my way and encourage us all its one day at a time.

Thank you
Mamie
 
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Good Morning, lovetocookandsew,

Thank you so much for giving this nasty pain a name. It has been awful at times and tolerable at times but I could not understand why. I accepted the reason they gave me of driving one end up half way in to the thigh and half way down the calf due to horrendous bone loss. It helps when things that are so important have a reason. Our hospitals around us are encouraging you stay away and it means it. Covid in running rapid when we have had low Covid count.

I will remember what you have said and hopefully he won't be so unkind again and will listen to me about this pain. My PT did not of it or she would have hopefully told me but tomorrow I see her again and will let her now.

I'll check back in Friday night or Saturday if anything goes too rough.

God Bless this group,
Mamie
 
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Jockette

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through will take time to heal. IMO having a MUA at this time will only cause further inflammation and swelling, risking a set back to your recovery.
I agree with Pumpkln.Your ROM will improve as your swelling goes down, which it is already doing. Force bending your knee, which is what an MUA is, (and why they have to do it under anesthesia, hence those initials=Manipulation Under Anesthesia) will cause more trauma to your already overtraumatized leg.

Please don’t let anyone make you feel that any of your issues are your fault. Your body is trying it’s hardest to heal in spite of the deplorable medical care you have gotten thus far. :console2:

My ROM came along very slowly my whole first year because I had a couple of big setbacks. But, it continued to improve the second year, and also in the third year after surgery! It really is true that there is no set time to improve ROM.
 

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I agree that you should not be having a MUA done now. Not only are you fighting swelling, but you are also fighting an infection, too. There is no time limit on gaining bend. It can't bend much when it's swollen. Think of a water hose that is full of water with the nozzle cut off so the water can go out. Now, try and roll that hose up tightly. Is it going to do it? Of course not. Your knee is the same way. You can't squish the water out of the way to make it bend more. If your incision is still weak, a MUA might force it to open again.

In no way did you cause your infection or your swelling. That is what is holding back your bend, not the way you have exercised. I think you have done more than you should have because of PT's pressure. Pat yourself on the back for trying so hard. But now you need to just slow down and let your knee heal naturally.
 

Pumpkln

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Mamie,
The ROM numbers in the examples are to show you that ROM increases slowly, there is no rush.
None of those members had a revision or an infection.
 

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Hi Mamie, sorry you are having a tough go of it. I agree give yourself and your knee more time. You have been contending with a lot, and a revision is a harder recovery. I’m praying things turn around for you and soon you are on your feet again. You are in my daily prayers.
 

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Mamie, I hope you take the comments from Pumpkln and others to heart. Extreme patience is required in your case because of all you've had going on and your general health situation. You haven't failed at anything other than maybe wanting to see faster progress than your body is willing to do right now. An MUA will add trauma to your knee. It's a forcible bending and straightening while your body is relaxed from the anesthetic. The purpose of an MUA is to break up excessive scar tissue (adhesions) in the rare case that they have formed and are limiting the joint movement. Since you know you have swelling that is restricting your knee, I don't see how anyone can definitively say that you may have adhesions. To me, the prudent thing for you to do is continue on your path of gentle movements each day and fight that urge that you need to do more.
 
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Mamie

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Good Evening My Friends!

I have been quiet today just resting and trying to figure out what kind of games are being played at medical appointments. First off, I was told there was nothing called "tip of stem pain" and that after 6 weeks under any circumstances he did not give a Rx for anything. I was instructed to find a different source such as a pain specialist or my GP. He ask where I heard that about a stem tip and I said a friend who suffered the same pain and it was their doctor who told them.

He said it was a regulation by the government all across the country that no surgeon can administer pain meds after six weeks. I barked back and said that I was not the one that caused my leg to be having these problems and if I could have just 2 weeks it would give me more time to heal and find someone to prescribe the meds. He said no.

They kept me around two hours waiting for one of them to come back to compression wrap my leg. Finally I got up and started to leave when the receptionist phoned them and they asked me to return to the exam room. Another 15 minutes passed. The PA came in and wrapped my leg and was really kind and I left to return in 6 weeks. In a way I think he was nervous since being called out about all the things that he forgot as his following comments were very strange. He told me at 84 degrees I was on target and the swelling would go away in time but to keep pushing harder to make it bend. I told him I would try but will not push it ever again. Also, I asked if on target why did he show disgust or disappointment when my numbers were lower and tell me I had failed getting to 90. He just swept my comment away and ignored it as though he had not heard it.

The PA had dug into the areas opening them to find a stitch that had not dissolved and said it was the cause of my infection. I do not buy that. He did not even look at it. I also ask about going back to therapy with home health care since the therapy clinic was so crowded and I was afraid to get sick when our county just got hit harder with COVID. He again said NO. Since they dug around it has made my leg hot and angry again, so today I took it off.

I am thinking I should call it all off and heal on my own the rest of the way. I feel I have already to this point, so why do I need him? I'm thinking of not keeping my mid October appointment. His newest "I expect" comment was I expect it to reach 125 in the next six weeks. From 84 to 125 in 6 weeks. I do not respect or believe in him anymore.

Do we need to have further watching at my stage of 7 weeks by the surgeon or can could I go to Internal med guy? He is giving me further meds as he know I never abuse anything. Sorry for the long message but I wanted to cover what everyone was kind enough to support.

In closing, what do you think of me quitting both returning to his office and going to PT after this next Thursday?

Many thanks to all of my new friends and know that you are all in my prayers. I am so thankful to each one here at Bone Smart.

Mamie


I am done.
 

sistersinhim

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The PA had dug into the areas opening them to find a stitch
Please explain this. It makes no sense to me at all. No one has any business opening up anything in your knee unless you are in a hospital under sterile conditions.
I am thinking I should call it all off and heal on my own the rest of the way.
With the covid and the actions of your surgeon and the PA I think you'd be much better off staying away from them. But, you do need an infectious disease doctor to monitor your infection. If I were you I would not trust your current OS. You need a specialist that knows infections.
 

lovetocookandsew

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Google "Tip of stem pain", or "stem tip pain" for yourself and you'll be surprised at how much info there is about it. I'm not saying you have this particular issue, I'm just saying it is a possible cause of pain and if you do have it, it'll go away eventually. Your doctor is a piece of work, IMHO. If it were me, I'd do what sistersinhim suggested; find an infectious disease doctor to handle the infection, and skip the OS altogether.

As for your ROM, it will begin to improve as the swelling goes down, but no one knows how long it will take. With all the issues you've had, my suspicion is that it will take longer than expected for the swelling to go down, but that it will happen. Let your knee heal from all the trauma it's been through, find an ID doctor and be very, very patient.
 

Pumpkln

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Mamie,
I have long stems from my revision and had stem pain/discomfort. The stem pain was gone by my one year anniversary.
I agree, see your primary MD for pain meds, and an ID for your infection.

You should consider cancelling your PT appointment, you all ready know what to do to allow your knee to heal.
 

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